Gastro hep advances最新文献

{"title":"Rates and Factors Associated With Hepatocellular Carcinoma Diagnosis, Stage, Treatment, and Survival","authors":"George N. Ioannou ,&nbsp;Vera Yakovchenko ,&nbsp;Tamar Taddei ,&nbsp;Alexander Monto ,&nbsp;Heather Patton ,&nbsp;Monica Merante ,&nbsp;Patrick Spoutz ,&nbsp;Linda Chia ,&nbsp;Jennifer Yudkevich ,&nbsp;Ayse Aytaman ,&nbsp;Atoosa Rabiee ,&nbsp;Binu John ,&nbsp;Boris Blechacz ,&nbsp;Cindy X. Cai ,&nbsp;Hochong Gilles ,&nbsp;Anand S. Shah ,&nbsp;Heather McCurdy ,&nbsp;Puneet Puri ,&nbsp;Janice Jou ,&nbsp;Khurram Mazhar ,&nbsp;Shari S. Rogal","doi":"10.1016/j.gastha.2025.100859","DOIUrl":"10.1016/j.gastha.2025.100859","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Up-to-date information is needed on hepatocellular carcinoma (HCC) diagnosis, stage, treatment, and survival.</div></div><div><h3>Methods</h3><div>Of &gt; 2000 patients with a new diagnosis of HCC in 2023 in the US Veterans Health Administration, a random subsample of 194 confirmed HCC cases were selected for a structured medical record review by expert hepatologists.</div></div><div><h3>Results</h3><div>Among 194 confirmed HCC cases in 2023, mean age was 73 years, and only 56.7% had cirrhosis diagnosed before HCC, while 12.9% had cirrhosis diagnosed after HCC and 22.2% did not have cirrhosis. Stage at diagnosis was T1 in 17.5%, T2 in 42.3%, and beyond T2 in 40.2%. Early-stage diagnosis (T1 or T2) was more common in the following groups: cirrhosis diagnosed before HCC (70.9%), HCC diagnosed by screening (86.3%), high performance status (73.0%), receipt of Veterans Affairs (VA) primary care (63.3%), or VA liver care (72.6%). Among 147 of 194 patients (75.8%) who received HCC-directed treatments, the most common, first-line treatment was Y-90 radioembolization (28.6%), followed by ablation (21.1%), transarterial chemoembolization (20.4%), systemic therapy (17.0%), surgical resection (7.5%), and external beam radiation (5.4%). Mortality (29.9% at 1 year, 44.8% at 2 years) was lower in those with early-stage diagnosis, diagnosis via screening, Child-Turcotte-Pugh class A, Model for End-Stage Liver Disease ≤ 10, absence of cirrhosis, cured hepatitis C virus, receipt of curative treatments, VA primary or liver care, and good performance status.</div></div><div><h3>Conclusion</h3><div>These results highlight the importance of HCC screening and engagement in liver care for early HCC diagnosis, curative treatment, and improved survival while demonstrating the feasibility of a national quality improvement program for addressing persistent gaps in the HCC screening, diagnosis, and treatment.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"5 3","pages":"Article 100859"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-Specific Differences in Outcomes and Trends in Patients With Ulcerative Colitis","authors":"Alissa Rothman ,&nbsp;Lara Chaaban ,&nbsp;Joanna Melia","doi":"10.1016/j.gastha.2025.100867","DOIUrl":"10.1016/j.gastha.2025.100867","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Sex-based differences in immune-mediated diseases are becoming more widely recognized, but there is very limited research exploring sex-based differences in ulcerative colitis (UC), particularly more severe forms of UC. Some recent studies have suggested lower colectomy rates in female patients with UC. The objective of this study is to assess the association between sex and outcomes of patients with UC, particularly those with more severe forms of the disease requiring hospitalization.</div></div><div><h3>Methods</h3><div>A propensity score matched retrospective cohort study was performed using TriNetX, a multi-institutional database, to compare risk of colectomy, hospitalization, and mortality between male and female patients with UC, including subgroup analyses of those who had been hospitalized, had received intravenous steroids within 2 weeks of hospitalization or had received infliximab within 1 month of hospitalization.</div></div><div><h3>Results</h3><div>Males had a statistically significant increased risk of colectomy (odds ratio (OR) 1.50, 95% confidence interval (CI) 1.40–1.61; OR 1.47, 95% CI 1.38–1.57), hospitalization (OR 1.04, 95% CI 1.02–1.06; OR 1.02, 95% CI 1.00–1.04), and mortality (OR 1.28, 95% CI 1.21–1.34; OR 1.32, 95% CI 1.28–1.37) at 1 year and at 5 years after diagnosis. Similar results were found when focusing on hospitalized UC patients and males receiving intravenous steroids within 2 weeks of hospitalization. For patients receiving infliximab within 1 month of hospitalization only colectomy rates were significantly different between males and females at the 1-year timepoint.</div></div><div><h3>Conclusion</h3><div>Male patients with UC are at higher risk for colectomy, hospitalization, and mortality than females with UC.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"5 3","pages":"Article 100867"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146168038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammatory Fibroid Polyp of the Small Intestine Presenting With Intussusception and Secondary Appendicitis, Successfully Treated Endoscopically","authors":"Kazuki Natsui ,&nbsp;Manabu Takeuchi ,&nbsp;Shuji Terai","doi":"10.1016/j.gastha.2025.100878","DOIUrl":"10.1016/j.gastha.2025.100878","url":null,"abstract":"","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"5 3","pages":"Article 100878"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146204045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Refractory Helicobacter pylori Infection","authors":"Bibek Saha,&nbsp;Martin Ventoso,&nbsp;Steven F. Moss","doi":"10.1016/j.gastha.2025.100872","DOIUrl":"10.1016/j.gastha.2025.100872","url":null,"abstract":"","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"5 3","pages":"Article 100872"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146230019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gas-forming Pyogenic Liver Abscess Mimicking Gastric Perforation in a Patient With Diabetic Ketoacidosis and Subsequent Rupture: A Case Report","authors":"Tairyu Sato ,&nbsp;Koki Yamada ,&nbsp;Akira Nishio ,&nbsp;Yuki Tokuda ,&nbsp;Chihiro Yamanaka ,&nbsp;Keishi Oka ,&nbsp;Kanako Morita ,&nbsp;Chihiro Tarumi ,&nbsp;Kazuna Hazu ,&nbsp;Yuki Nishiura ,&nbsp;Kumi Higashihara ,&nbsp;Shogo Nagahama ,&nbsp;Takayuki Matsumae ,&nbsp;Tadashi Kegasawa ,&nbsp;Aya Ishimi ,&nbsp;Satoshi Hiyama ,&nbsp;Katsumi Yamamoto ,&nbsp;Nobuyuki Tatsumi ,&nbsp;Osakuni Morimoto ,&nbsp;Akira Kaneko","doi":"10.1016/j.gastha.2025.100851","DOIUrl":"10.1016/j.gastha.2025.100851","url":null,"abstract":"<div><div>A 53-year-old man with uncontrolled diabetes presented with fever and diabetic ketoacidosis. Computed tomography revealed a large hepatic lesion containing mottled gas, but the origin was uncertain, delaying drainage and raising concern for gastric perforation. Next-morning computed tomography showed hepatic gas and free intraperitoneal air, yet abdominal findings were minimal. During percutaneous drainage planning, he developed sudden abdominal pain and septic shock, illustrating the rapid, life-threatening course of gas-forming pyogenic liver abscess. Urgent laparoscopy confirmed rupture; Klebsiella pneumoniae was isolated. This case highlights diagnostic challenges and need for prompt reassessment and source control. Uncontrolled diabetes and ketoacidosis likely accelerated gas-forming pyogenic liver abscess rupture.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"5 2","pages":"Article 100851"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145840182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Clinical Significance of Extrapancreatic Incidental Findings Detected During Pancreas Surveillance","authors":"Helena Saba ,&nbsp;Elizabeth Abou Diwan ,&nbsp;Hassan Sinan ,&nbsp;Dimitri Melki ,&nbsp;Mohamad Dbouk ,&nbsp;Amanda Blackford ,&nbsp;Linda Chu ,&nbsp;Eun Ji Shin ,&nbsp;Marcia Irene Canto ,&nbsp;Michael Goggins","doi":"10.1016/j.gastha.2025.100818","DOIUrl":"10.1016/j.gastha.2025.100818","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Cancer screening tests have the potential to detect cancers and precancerous conditions, but one concern is the potential that screen-detected incidental findings lead to unnecessary, potentially harmful interventions. The aim of this study is to determine, the yield of extrapancreatic incidental findings that required management, including cancers, precancerous lesions, and other findings of diagnostic concern in patients undergoing pancreatic surveillance for their familial or genetic pancreatic cancer risk.</div></div><div><h3>Methods</h3><div>We reviewed the pancreatic surveillance records of 925 patients enrolled in the Cancer of Pancreas Screening studies at The Johns Hopkins Hospital from 1998 to 2023 who had undergone at least one pancreatic surveillance test. Significant extra-pancreatic incidental findings that required diagnostic evaluation and/or treatment were tabulated, including the resulting diagnostic tests, therapeutic interventions, and complications.</div></div><div><h3>Results</h3><div>The mean age/standard deviation at enrollment, of patients in the cohort was 58.0/10.4 years; 59.7% female), 220 (23.8%) had undergone baseline surveillance, 705 (76.2%) had undergone surveillance for a median of 4 years. Seventy-five extrapancreatic incidental findings were detected in 68 patients (7.3%), including 10 cancers, 80% of which were stage I and 8 (0.86%) precancerous lesions. Thirteen patients underwent surgical (n = 13), endoscopic (n = 9), or chemotherapy (n = 4). Twenty-five patients (2.7%) were recommended to undergo surveillance, (20 for nondysplastic Barrett’s esophagus). Three patients (0.33%) were considered overtreated in retrospect (2 cholecystectomies, 1 partial nephrectomy, all laparoscopic). One patient had a postoperative complication treated successfully.</div></div><div><h3>Conclusion</h3><div>Extrapancreatic incidental findings are commonly detected in patients undergoing pancreatic surveillance, but few signify serious pathology. Almost all interventions for incidental findings were for cancerous and precancerous lesions, with few instances of unnecessary interventions.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"5 2","pages":"Article 100818"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Type 1 Autoimmune Pancreatitis in a Teenager With Ulcerative Colitis: A Case Report","authors":"Jerry H. Rose ,&nbsp;Michael J. Sikorski ,&nbsp;Patrick W. Ruane ,&nbsp;Dania Hudhud ,&nbsp;Abdulhameed M. Al-Sabban","doi":"10.1016/j.gastha.2025.100834","DOIUrl":"10.1016/j.gastha.2025.100834","url":null,"abstract":"<div><div>Type 2 autoimmune pancreatitis (AIP) is a recognized complication of ulcerative colitis (UC), whereas type 1 AIP—an immunoglobulin G4-related sclerosing pancreatitis—is uncommon in this patient population and typically presents in older males. We present a case of recurrent pancreatitis in an 18-year-old male with UC. Investigations revealed elevated immunoglobulin G4 levels and images demonstrating diffuse pancreatic strictures and parenchymal enlargement, consistent with type 1 AIP. The patient showed a favorable response to glucocorticoid therapy. This case highlights a potential new association between AIP and UC and emphasizes early recognition and treatment.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"5 2","pages":"Article 100834"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Potent Engineered Microbial Lipase for the Treatment of Exocrine Pancreatic Insufficiency","authors":"Christos S. Karamitros ,&nbsp;Chinping Chng ,&nbsp;William Casey Hallows ,&nbsp;Ravi Garcia ,&nbsp;Kristen Skvorak ,&nbsp;Adam Silverman ,&nbsp;Nikki Kruse ,&nbsp;Judy Viduya ,&nbsp;Stephanie Galanie ,&nbsp;Da Duan ,&nbsp;Kerryn McCluskie ,&nbsp;Robert K. Sato ,&nbsp;John Watson ,&nbsp;Alek Zajac ,&nbsp;Carmine D’Urzo ,&nbsp;Sharan Ghuman ,&nbsp;Edward Edson ,&nbsp;Ismail Aouadi ,&nbsp;Chris Wynne ,&nbsp;John Windsor ,&nbsp;Bernard Cuenoud","doi":"10.1016/j.gastha.2026.100984","DOIUrl":"10.1016/j.gastha.2026.100984","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Exocrine pancreatic insufficiency (EPI) is a chronic condition associated with inadequate digestive enzyme secretion from the pancreas, causing impaired digestion, malabsorption, and malnutrition. EPI affects 10%–20% of the general population, and the standard of care includes pancreatic enzyme replacement therapy (PERT) that is exclusively derived from porcine pancreatic extracts. However, PERT is associated with several limitations, including suboptimal efficacy, which results in increased pill burden and high treatment costs. This work aimed to identify and engineer a potent microbial lipase that can function in the gastrointestinal tract without needing enteric coating and capable of hydrolyzing a wide range of dietary fats for the development of an alternative PERT.</div></div><div><h3>Methods</h3><div>State-of-the-art protein engineering and biochemical characterization techniques were applied to optimize and characterize a therapeutically relevant lipase. The lipase was evaluated in a pancreatic duct ligation minipig model, as well as in a clinical trial involving healthy subjects and EPI patients.</div></div><div><h3>Results</h3><div>The engineered lipase exhibited very high stability under simulated gastric and intestinal conditions while it can hydrolyze a wide range of dietary fats. Coefficient of fat absorption analysis demonstrated that the enzyme enabled pancreatic duct ligation minipigs to digest fat at levels comparable to porcine-derived PERT while using 10-fold lower dosing by mass of non–enteric-coated recombinant protein vs porcine PERT. Clinically, patients with EPI receiving orally administered lipase demonstrated a favorable safety profile and improvement of fat absorption as assessed by a ¹³CO₂-mixed triglyceride breath test in a proof-of-concept, integrated phase 1a-1b clinical trial.</div></div><div><h3>Conclusion</h3><div>These results provide a foundation for the clinical development of a novel engineered recombinant lipase for treating EPI and warrant further evaluation in clinical trials.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"5 7","pages":"Article 100984"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148180162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Kårhus et al. Regarding “Ruminococcus gnavus and Biofilm Markers in Feces From Primary Bile Acid Diarrhea Patients Indicate New Disease Mechanisms and Potential for Diagnostic Testing”","authors":"Evette B.M. Hillman,&nbsp;Julian R.F. Walters,&nbsp;Danielle Carson ,&nbsp;Sjoerd Rijpkema","doi":"10.1016/j.gastha.2026.100951","DOIUrl":"10.1016/j.gastha.2026.100951","url":null,"abstract":"","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"5 7","pages":"Article 100951"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148180123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Practical Framework for the Creation of a National Mentorship Program Within the American Gastroenterological Association","authors":"Molly L. Stone,&nbsp;Adam E. Mikolajczyk","doi":"10.1016/j.gastha.2026.100981","DOIUrl":"10.1016/j.gastha.2026.100981","url":null,"abstract":"","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"5 8","pages":"Article 100981"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148183581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}